Provider Demographics
NPI:1467120410
Name:BEAUTIFUL MOUNTAIN MASSAGE THERAPY P.C
Entity Type:Organization
Organization Name:BEAUTIFUL MOUNTAIN MASSAGE THERAPY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT CMMT
Authorized Official - Phone:718-513-9543
Mailing Address - Street 1:20417 HILLSIDE AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2213
Mailing Address - Country:US
Mailing Address - Phone:718-513-9543
Mailing Address - Fax:
Practice Address - Street 1:18341 DUNLOP AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11412-1511
Practice Address - Country:US
Practice Address - Phone:718-513-9543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty